Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy.
The Liver-Brain Unit "Rita Moretti", Italian Liver Foundation, 34149 Trieste, Italy.
Int J Mol Sci. 2022 Dec 8;23(24):15564. doi: 10.3390/ijms232415564.
Celiac disease (CD) is a complex multi-organ disease with a high prevalence of extra-intestinal involvement, including neurological and psychiatric manifestations, such as cerebellar ataxia, peripheral neuropathy, epilepsy, headache, cognitive impairment, and depression. However, the mechanisms behind the neurological involvement in CD remain controversial. Recent evidence shows these can be related to gluten-mediated pathogenesis, including antibody cross-reaction, deposition of immune-complex, direct neurotoxicity, and in severe cases, vitamins or nutrients deficiency. Here, we have summarized new evidence related to gut microbiota and the so-called "gut-liver-brain axis" involved in CD-related neurological manifestations. Additionally, there has yet to be an agreement on whether serological or neurophysiological findings can effectively early diagnose and properly monitor CD-associated neurological involvement; notably, most of them can revert to normal with a rigorous gluten-free diet. Moving from a molecular level to a symptom-based approach, clinical, serological, and neurophysiology data might help to disentangle the many-faceted interactions between the gut and brain in CD. Eventually, the identification of multimodal biomarkers might help diagnose, monitor, and improve the quality of life of patients with "neuroCD".
乳糜泻（CD）是一种复杂的多器官疾病，其肠道外受累的患病率很高，包括神经系统和精神表现，如小脑共济失调、周围神经病、癫痫、头痛、认知障碍和抑郁。然而，CD 中神经受累的机制仍存在争议。最近的证据表明，这些可能与麸质介导的发病机制有关，包括抗体交叉反应、免疫复合物沉积、直接神经毒性，在严重情况下，还与维生素或营养物质缺乏有关。在这里，我们总结了与 CD 相关的神经表现有关的新的肠道微生物组和所谓的“肠-肝-脑轴”的证据。此外，对于是否可以通过血清学或神经生理学发现有效早期诊断和适当监测 CD 相关的神经受累，尚未达成共识；值得注意的是，大多数神经病变在严格的无麸质饮食下可恢复正常。从分子水平到基于症状的方法，临床、血清学和神经生理学数据可能有助于理清 CD 中肠道和大脑之间的多方面相互作用。最终，多模态生物标志物的鉴定可能有助于诊断、监测和提高“神经 CD”患者的生活质量。
